• Local anesthetic injected into nerves so area that area supplied is dulled
• Two types: spinal and conduction blocks

• One of two types of regional anasthesia
• Injected into subarachnoid space of spinal cord, usually L2 causing loss of movement and feeling in lower extremities, lower abdomen and perineum

One of two types of regional anesthesia

Are 3 types of conduction blocks

-----EPIDURAL

-----TRANSSACRAL/CAUDAL

-----BRACHIAL PLEXUS

• One of three kinds of regional conduction blocks
•   injected into space around dura of spinal cord

One of three kinds of regional conduction blocks

injected into epidural space at level of sacrococcygeal notch

One of three types of regional conduction blocks

Injected into brachial plexus

For surgery of upper extremities

Usaully the PCP or dentist

A nurse may apply topical anasthesia

a.       Uses – given before anesthesia, usually before general; may be one drug or a combination; chosen by anesthesiologist

                                                               i.      Opioid/antianxiety/sedative- e.g fentanyl, lorezepam, droperidol

                                                             ii.      Cholinergic blocking – decreases upper resp secretions (e.g. glycopyrrolate = Robinul); cough and swallow reflexes lost during general and secretions could pool in lungs

                                                            iii.      Antiemetic to decrease n/v – hydroxyzine (also antianxiety)

                                                               i.      Barbituates and similar agents – includes propofol=Diprivan

                                                             ii.      Benzodiazepines – e.g.midazolam

                                                          iii.      Ketamine

                                                           iv.      Gases and Volitile Liquids (evaporate upon exposure to air) – e.g. Nirous Oxide; enflurane, halothane, isoflurane, methoxyflurane, desflurane, sevoflurate (These drugs will ***FLUR*** you)

                                                             v.      Opioids like fentanyl used with droperidol (a major tranquilizer) may cause a very relaxed analgesia = NEUROLEPTANALGESIA although use of droperidol assoc with fatal cardiac arrythmias; another opioids for general anesthesia is remifentanil=Ultiva

                                                           vi.      Skeletal Muscle Relaxants – for certain surgeries where muscles must be relaxed; e.g. atracurium, doxacurium, pancuronium.

                                                               i.      Stage 1 – induction until consciousness is lost, may only be 5-10 seconds; personal stay quiet and still as possible during this and next stage

                                                             ii.      Stage 2 – delirium and excitement and pt may mumble and move about, but unconscious.  At this stage a person would physically react to pain, but not remember; noises cause extreme response, stay quiet and still (personel); also brief.

                                                            iii.      Stage 3 = SURGICAL ANESTHESIA, split into four levels of depth

                                                           iv.      Stage 4 – dangerous respiratory paralysis; all vital signs could cease.

• Preanesthesia – perform task as required by physician and hospital policy and chart
• Check chart for recent abnormal test results, chart and notify surgeon and anesthesiologist
• Place list of known or suspected drug allergies on front of chart
• Admin preanesthetic
• Instructing pt to remain in bed and put up rails once preanesthestic administered
• Postanesthesia – specific to PACU